Open inguinal hernia repair with lightweight mesh resulted in a lower-level sensation of groin lump and less discomfort at 1 year in a group of patients who had lightweight mesh, compared with patients who had heavyweight mesh, in a multicenter, randomized clinical trial.

Martin Rutegård, MD, of Umeå (Sweden) University, and his research associates reported that 3%-10% of all hernia surgeries “result in severe or moderately severe pain for more than a year after hernia surgery, which may have a significant impact on social activities, sex life, and quality of life. ... Interest in the use of lightweight meshes in groin hernia repair has increased in recent years, as it is assumed that this type of mesh may cause less discomfort and chronic pain.”

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Open hernia surgery

The research team explored this question by conducting an “expertise-based” investigation in which surgeons used their preferred mesh weight to repair inguinal hernia. Patients were allocated to one of two groups of surgeons after randomization.

Patients were followed for 1-3 years and given questionnaires to report their outcomes. Patients were all male and were close in weight (mean body mass index, 25.2 kg/m2 in the lightweight-mesh group and 25.3 in the heavyweight-mesh group), age (59 and 58, respectively), and American Society of Anaesthesiologists classification of their hernia defect.

Of a total of 363 patients, 185 patients were randomized to the lightweight-mesh group and 178 patients to the heavyweight group. Investigators found that there were significant differences concerning awareness of a groin lump and groin discomfort, favoring the lightweight group 1 year after surgery. A total of 6% of the lightweight group reported the groin lump awareness at 1 year, vs. 18% of the heavyweight group. Groin discomfort was reported by 18% of the lightweight group and 28% of the heavyweight group.

After 1 year, that difference subsided. In terms of discomfort, the investigators found no statistically significant or clinically relevant differences between types of mesh, with 263/288 patients (91.3%) reporting improvement after 12 months, 19/288 patients (6.6%) experiencing no change, and 6/288 patients (2.1%) having worsened.

Additionally, there was no statistically significant difference in quality of life as measured by the EuroQol five dimensions (EQ-5D) between the different mesh groups. It was noted that all the patients had a statistically significantly better quality of life postoperatively from day 11 and onward, compared with before surgery. In addition, the investigators did not detect a significant difference between the mesh groups in their reported sexual life after surgery at 4 and 12 months subsequent to the operation.

The recurrence rate at the follow-up visit and clinical examination was 2.4% and equal between both groups.

The study was limited by possible bias of the expertise-based design and also some missing data, especially with regard to sexual life after surgery.

The study was funded by the Västerbotten County Council, VISARE NORR Fund, and Northern Country Councils Regional Federation. The investigators reported no conflicts of interest.